加味桃红四物汤联合生长因子凝胶治疗糖尿病足伴下肢慢性缺血的效果

Efficacy of modified Taohong Siwu Decoction combined with growth factor gel for diabetes foot patients with chronic lower limb ischaemia

目的探讨糖尿病足伴下肢慢性缺血患者实施加味桃红四物汤联合生长因子凝胶(GFG)治疗的临床价值。方法筛选2020年9月至2021年9月河南省直第三人民医院收治的90例糖尿病足伴下肢慢性缺血患者,依据随机数表法分为A组(对照组)、B组(GFG组)、C组(GFG联合加味桃红四物汤组),每组各30例;其中A组实行常规局部清创、换药、抗炎、改善循环治疗,B组在常规治疗的基础上合用GFG,C组在常规治疗基础上联合加味桃红四物汤与GFG治疗;比较三组创面细胞增殖相关基因的表达、患侧踝肱指数、足背血流速度、炎症因子水平、创面面积及深度。结果治疗前,三组β-catenin、cyclin1表达复合表达分数(CES)比较,差异无统计学意义(P>0.05);治疗后,C组β-连环蛋白(β-catenin)、细胞周期蛋白1(cyclin 1)CES明显高于A组、B组,差异有统计学意义(P<0.05);治疗前,三组踝肱指数(ABI)、足背血流速度比较,差异无统计学意义(P>0.05);治疗后,C组ABI、足背血流速度明显高于A组、B组,差异有统计学意义(P<0.05);治疗前,三组炎症因子水平比较,差异无统计学意义(P>0.05);治疗后,C组白细胞介素-6(IL-6)、C反应蛋白(CRP)显著低于A组、B组,差异有统计学意义(P<0.05);治疗前,三组创面面积及深度比较,差异无统计学意义(P>0.05);治疗后,C组创面面积及深度明显低于A组、B组,差异有统计学意义(P<0.05)。结论糖尿病足伴下肢慢性缺血患者在常规治疗的基础上,辅助加味桃红四物汤与GFG治疗,有助于调节创面细胞增殖相关基因的表达,改善下肢动脉循环及血供,减轻炎症水平,提高血管内皮功能,进而促进创面更快愈合,改善患者预后。

Objective To explore the clinical value of modified Taohong Siwu Decoction combined with growth factor gel(GFG)in the treatment of diabetes foot patients with chronic lower limb ischaemia.Methods A total of 90 diabetes foot patients with chronic lower limb ischaemia admitted to Henan No.3 Provincial People’s Hospital from September 2020 to September 2021 were screened and divided into Group A(the control group),Group B(the GFG group),and Group C(the GFG combined with modified Taohong Siwu Decoction group)according to random number table method.There were 30 cases in each group.Group A was treated with routine local debridement,dressing change,anti-inflammation and circulation improvement,Group B was supplemented with GFG on the basis of routine treatment,and Group C was treated with modified Taohong Siwu Decoction and GFG on the basis of routine treatment.The expression of genes related to wound cell proliferation,ankle brachial index(ABI)of the affected side,dorsalis pedis blood flow velocity,inflammatory factor level,wound area and depth were compared among the three groups.Results Before treatment,there were no statistically significant differences in the composite expression scores(CES)ofβ-catenin and cyclin1 expression among the three groups(P>0.05).After treatment,the CES scores ofβ-catenin and cyclin1 expression in Group C were significantly higher than those in groups A and B,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in ankle/brachial index(ABI)and dorsalis pedis blood flow velocity among the three groups(P>0.05).After treatment,the ABI and dorsalis pedis blood flow velocity in Group C were significantly higher than those in groups A and B,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in the levels of inflammatory factors among the three groups(P>0.05).After treatment,the levels of interleukin 6(IL-6)and C-reactive protein(CRP)in Group C were significantly lower than those in groups A and B,with statistically significant differences(P<0.05).Before treatment,there were no statistically significant differences in the wound area and depth among the three groups(P>0.05).After treatment,the wound area and depth in Group C were significantly smaller or less than those in groups A and B,with statistically significant differences(P<0.05).Conclusion For diabetes foot patients with chronic lower limb ischaemia,the addition of modified Taohong Siwu Ddecoction and growth factor gel on the basis of routine treatment can help regulate the expression of genes related to wound cell proliferation,improve arterial circulation and blood supply of lower limbs,reduce inflammation level,enhance vascular endothelial function,further promote faster wound healing,and strengthen the prognosis.